Stress and Osteoporosis

We all experience stressful times in our lives, perhaps even daily. We know it’s not good
for us, but we may not realize that it can impact our bone-related health. Whether it’s
work related, family related, environmental, physical or emotional, stress causes our
bodies to fall out of balance and can actually cause the diminishing of calcium in our
bones!

When we are stressed, our bodies release a “stress hormone” called cortisol, which
causes havoc on our system. To help bring our bodies back in balance, our system
releases calcium from our bones and teeth – similar to how antacids neutralize stomach
acid. The calcium helps neutralize the ph balance of the cortisol, helping restore our
bodies to neutral. Each time we do this we deplete calcium stores from our bones. The
simple answer is eat more dairy and we should be fine, but it’s not that straightforward.

When stress becomes chronic, our diets cannot replace the calcium depletion fast
enough so our bones are constantly being leached of calcium, leading to potentially
more porous bones, brittle bones and osteoporosis.

Stress may also cause us to eat more, eat the wrong types of foods, skip a work out, or
interrupt sleep patterns – all of which impact our system, including our bones.

At this point you may wonder if this situation is hopeless, which may in fact add more
stress. But there are things you can do to relieve your stress and help strengthen your
bones. You can exercise! It’s a great stress reliever, especially weight-bearing exercise.
We also recommend meditation to help lower stress impulses, deep breathing, sleeping
seven to eight hours a night if possible and adjusting your diet to increase calcium to
fight your calcium-depleting stress. Taking a nutritional supplement to help build up your
calcium may also help.

So next time you are feeling stressed, consider taking up one of your favorite pastimes,
perhaps gardening, going for a walk with friends, playing with your kids or pets in the
backyard or at the park – anything to help clear your mind, put you at ease and expose
you to fresh air. Not only does it benefit your bones it also exposes our skin to naturally
occurring vitamin D in sunshine which as we learned in our previous post helps in the
absorption of calcium.
Calcium is not only the most abundant mineral in bone, it is also the most abundant
mineral in the human body. Calcium ions are needed not only for bone mineralization
but for tooth health, regulation of the heart rate and strength of contraction, blood
coagulation, contraction of smooth and skeletal muscle cells, and regulation of nerve
impulse conduction. The normal level of calcium in the blood is about 10 mg/dL.
When the body cannot maintain this level, a person will experience hypo- or
hypercalcemia.

Hypocalcemia, a condition characterized by abnormally low levels of calcium, can

have an adverse effect on a number of different body systems including circulation,
muscles, nerves, and bone. Without adequate calcium, blood has difficulty
coagulating, the heart may skip beats or stop beating altogether, muscles may have
difficulty contracting, nerves may have difficulty functioning, and bones may become
brittle. The causes of hypocalcemia can range from hormonal imbalances to an
improper diet. Treatments vary according to the cause, but prognoses are generally
good.

Conversely, in hypercalcemia, a condition characterized by abnormally high levels of

calcium, the nervous system is underactive, which results in lethargy, sluggish
reflexes, constipation and loss of appetite, confusion, and in severe cases, coma.

Obviously, calcium homeostasis is critical. The skeletal, endocrine, and digestive

systems play a role in this, but the kidneys do, too. These body systems work together
to maintain a normal calcium level in the blood (Figure 6.7.1).

Calcium is a chemical element that cannot be produced by any biological processes.

The only way it can enter the body is through the diet. The bones act as a storage site
for calcium: The body deposits calcium in the bones when blood levels get too high,
and it releases calcium when blood levels drop too low. This process is regulated by
PTH, vitamin D, and calcitonin.

Cells of the parathyroid gland have plasma membrane receptors for calcium. When
calcium is not binding to these receptors, the cells release PTH, which stimulates
osteoclast proliferation and resorption of bone by osteoclasts. This demineralization
process releases calcium into the blood. PTH promotes reabsorption of calcium from
the urine by the kidneys, so that the calcium returns to the blood. Finally, PTH
stimulates the synthesis of vitamin D, which in turn, stimulates calcium absorption
from any digested food in the small intestine.
 When all these processes return blood calcium levels to normal, there is enough
calcium to bind with the receptors on the surface of the cells of the parathyroid glands,
and this cycle of events is turned off (Figure 6.7.1).

When blood levels of calcium get too high, the thyroid gland is stimulated to release
calcitonin (Figure 6.7.1), which inhibits osteoclast activity and stimulates calcium
uptake by the bones, but also decreases reabsorption of calcium by the kidneys. All of
these actions lower blood levels of calcium. When blood calcium levels return to
normal, the thyroid gland stops secreting calcitonin.

Chapter Review
Calcium homeostasis, i.e., maintaining a blood calcium level of about 10 mg/dL, is
critical for normal body functions. Hypocalcemia can result in problems with blood
coagulation, muscle contraction, nerve functioning, and bone strength. Hypercalcemia
can result in lethargy, sluggish reflexes, constipation and loss of appetite, confusion,
and coma. Calcium homeostasis is controlled by PTH, vitamin D, and calcitonin and
the interactions of the skeletal, endocrine, digestive, and urinary systems.

Critical Thinking Questions

1. An individual with very low levels of vitamin D presents themselves to you
complaining of seemingly fragile bones. Explain how these might be connected.

2. Describe the effects caused when the parathyroid gland fails to respond to calcium
bound to its receptors.

Solutions
Answers for Critical Thinking Questions

1. Vitamin D is required for calcium absorption by the gut. Low vitamin D could
lead to insufficient levels of calcium in the blood so the calcium is being released
 from the bones. The reduction of calcium from the bones can make them weak and
subject to fracture.
2. Under “normal” conditions, receptors in the parathyroid glands bind blood
calcium. When the receptors are full, the parathyroid gland stops secreting PTH. In
the condition described, the parathyroid glands are not responding to the signal
that there is sufficient calcium in the blood and they keep releasing PTH, which
causes the bone to release more calcium into the blood. Ultimately, the bones
become fragile and hypercalcemia can result.

Calcium is the primary material in bones. Calcium is our material. Its levels are
regulated metabolically with the feedback loop involving hormones/ In terms of
metabolism, we are simply referring to chemical reactions and processes that occur
within our body. And hormones are messengers that stimulate specific responses from
different areas in the body through feedback mechanisms which are simply just a
cause-and-effect circuits the feedback into themselves.

Why do we need calcium in the blood? Well, calcium is necessary muscle and nerve
function as well as blood clotting. It is important to know that calcium is a necessary
element of blood plasma.

So let’s now examine calcium metabolism and more specifically, the feedback loop that
keeps calcium levels within the blood constant.

The body works constantly to maintain stable balanced conditions. This is known as
homeostasis. There are two glands that work to maintain blood calcium homeostasis,
the thyroid and the parathyroid gland. Both of these glands make and release hormones
that work to maintain this balance. When the body has low blood calcium levels, the
parathyroid gland reacts by secreting parathyroid hormone also known as PTH. PTH
increases blood calcium levels by activating osteoclasts. Osteoclasts are responsible for
breaking down the bone to release calcium from the bone into the bloodstream. PTH
also activates Vitamin D and Vitamin D increases the amount of calcium that is
absorbed through the kidneys and through the small intestine. So as you can see,
parathyroid hormone or PTH C acts to increase calcium levels in the blood.

Now you may have been thinking “What? I thought Vitamin was a tool used to build
bone.” And this is correct. Vitamin D is an essential tool for bone building, and if we
recall, bone building involves taking calcium from the bloodstream and using it as a
primary material to build bones, thereby decreasing blood calcium levels. And we also
see the another role of Vitamin D is to increase kidney and intestine calcium absorption.
And what that means is that more calcium is going to be absorbed from the kidneys and
intestines instead of being flushed out of the body through the urine or stool thereby
increasing blood calcium levels. So we can see that Vitamin D serves two completely
different functions: one that acts to decrease blood calcium levels and the other the
blood calcium levels.

So let’s now examine the other side of blood calcium homeostasis. What happens when
calcium levels in the blood are too high? When there are high levels of calcium in the
bloodstream, the thyroid gland produces calcitonin. Calcitonin is a hormone that
increases bone building, meaning that more calcium goes from the bloodstream into the
bones. And how does calcitonin do this? Well, you can think of calcitonin as a police
officer who is stopping the vandals from taking apart the building. Thus calcitonin stops
the osteoclasts from doing their job. Calcitonin also inhibits the reabsorption of calcium
within the kidneys. This means that more calcium is flushed out of the body through
urine, thus lowering calcium levels within the bloodstream. So basically, when blood
calcium levels are high, calcitonin is secreted which signals for osteoclasts to be
inhibited and for the reabsorption of calcium in the kidneys to be inhibited. Thus, blood
calcium is decreased.

So let’s review blood calcium homeostasis. When calcium levels in the bloodstream are
too low, the parathyroid gland releases parathyroid hormone or PTH. PTH acts to
activate osteoclasts as well as activates vitamin D which if we recall works to increase
the amount of calcium that is absorbed into the bloodstream through the kidneys and
through the intestines. Thus calcium levels within the bloodstream rise. And when
calcium levels within the bloodstream are too high the thyroid gland produces calcitonin.
And calcitonin acts to inhibit osteoclast activity as well as inhibit the reabsorption of
calcium through the kidney. Thus calcium levels within the bloodstream will fall. And
here is the summary of how these two systems maintain blood calcium homeostasis.

Lastly, review the different roles of Vitamin D. So Vitamin D is an essential tool for
building bones. And when it is used to help build bones, this decreases blood calcium
levels. But vitamin D is also important in increasing kidney intestine calcium absorption
and when it serves this function, it acts to increase blood calcium levels.

I hope our presentation has helped you to better understand how calcium levels are
regulated metabolically through a feedback loop involving calcitonin and the parathyroid
hormone. And remember the purpose of this feedback loop is to ensure that calcium
levels into the bloodstream remain constant. So no matter if we’re trying to increase
calcium levels or decrease calcium levels, the purpose is to reach this homeostatic
balance